DAVID STERN, MD (Practice Velocity) Updates to the ICD-9 code set went into effect October 1, 2010. There will be one more regularly scheduled ICD-9 update on October 1, 201, the vastly larger ICD-10 code set is scheduled to take effect. The following are changes that are of particular interest to us in the urgent care field: New code to specify post-traumatic seizures: When a patient experiences seizure(s) as a result of a head injury, …
Read MoreCoding for Rectal Strep and Injury Exposure Visits, Billing for Slit Lamp Exams, and a Follow-up on Splinting
DAVID STERN, MD (Practice Velocity) Q. What is the correct ICD-9 code for rectal strep? Question submitted by Cindy Reisbeck, Littleton, CO A. There are several possible codes. The specific ICD-9 code would depend on a more specific diagnosis. For streptococcal infections in the rectal or perirectal area, there are several possible correct codes, as streptococcal species can cause multiple different types of localized conditions. For cellulitis, the correct code would be 566; for erysipelas, …
Read MoreCoding for Splints, Modifier–QW, Routine Rechecks, and Language Barriers to Efficient Coding
DAVID STERN, MD (Practice Velocity) Q. For splinting, our physicians use Ortho-Glass. At one time we billed out by the inch for it, but now some are saying that you cannot bill for it, as it is included in the E/M level charge. This does not make sense to me, so we’re looking for an expert opinion. Can you help me with this coding dilemma or point me in the right direction? Question submitted by …
Read MoreCoding for ‘Feared Complaint,’ Facility E/M Codes, and Nuances in Complexity of Medical Decision-making
DAVID STERN, MD (Practice Velocity) Q. We recently coded a visit for a young woman who thought – although she had no symptoms or foreign-body sensation – that there was a tampon left in her vagina. On pelvic exam, however, no retained tampon was found. What ICD-9 code is appropriate? Should the physician still diagnose this as a foreign body in the vagina? Question submitted by Japhlet Aranas, Resurrection Healthcare, Illinois A. One should not …
Read MoreWriting Off Patient Responsibility, Modifier-51, and More on New vs. Established E/M Codes
DAVID STERN, MD (Practice Velocity) Q. I listened to your UCA coding webinar, and it raised a question. You mentioned that if we bill insurance for a 99051 and the payor denies payment as “patient responsibility,” then we should bill the patient and not write it off. Does that hold true to the S9088, as well? I often see this code either denied or applied to the patient’s coinsurance/deductible. Question submitted by Megan Fontenot, Integrity …
Read MoreCoding X-Rays Ordered by Outside Docs, G-code for Drug Testing, and 99051 for Scheduled Visits
DAVID STERN, MD (Practice Velocity) Q. We have quite a few primary care physicians who regularly send patients to our urgent care center for x-rays. These patients have a prescription for the x-ray service, and they don’t want to be seen by the urgent care doctor. I have several questions related to this service: Should we collect the urgent care copay (or) radiology imaging services copay (which is usually $0)? Should we code S9083 to …
Read MoreCoding for Two Visits in One Day, Billing for Atypical Urgent Care Services, and Billing on the UB-04
Q. The patient in question is a new patient to the urgent care. At 10 a.m., she visited the urgent care with chief complaint of cough, headache, and myalgias. She was discharged home with a final diagnosis of cough and prescription for ibuprofen and cough syrup. At 3 p.m., she retuned with a complaint of headache and was treated with IM headache medications and sent home with a diagnosis of headache with pain meds. How …
Read MoreSplint Applications by Staff, and Proper Use ofModifiers -25, -26, and -59
Q. At the UCA Fall Urgent Care conference, you welcomed all questions, so here goes: Can you please let me know if it is appropriate to charge for Ortho-Glass and fiberglass splints in the urgent care setting? In some cases, the splints are applied by a tech under the direct supervision of the physician. In other cases, can the charge for the application of the splint be coded in addition to the Q code? Question …
Read MoreS9083 & Secondary Insurance, Laceration Repair, and More
Q. We bill S9083 to several carriers. Occasionally, a patient will have secondary insurance. If the primary insurance is contracted to pay S9083 code but transfers the balance to the deductible, how do we bill the secondary carrier if they do not accept the code? Question submitted by Paula Seify, Back Office MD A. Many secondary payors do not accept S9083, but these payors still will often cover the actual services that were rendered under …
Read MoreProper Use of 99051, and the Status of S9088
Q. Can I bill the CPT code 99051 (Services(s) provided in office during regularly scheduled, weekend, or holiday office hours, in addition to basic service) for the purpose of getting a denial? Can I bill a Medicare patient for the 99051 code if I have an advanced beneficiary notice (ABN) completed? Anonymous, Texas A. This is a very interesting question, and I am sure it will generate significant controversy. In regard to your question about …
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